Riveiro-Barciela Mar, Soler Maria Jose, Barreira-Diaz Ana, Bermejo Sheila, Bruera Sebastian, Suarez-Almazor Maria E
Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
J Clin Med. 2022 Oct 11;11(20):5977. doi: 10.3390/jcm11205977.
There are differences in recommendations for the management of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). To assess the real-world management of irAEs, three surveys regarding ICI-induced hepatitis (IIH), renal irAEs, and myositis were developed and sent to experts in each area. Fifty-six surveys were completed (17 IIH, 20 renal irAEs, and 19 myositis). All experts agreed on performing imaging in every suspected case of severe IIH. Sixty-five percent agreed on performing a liver biopsy in patients not responding to corticosteroids. The most common indication for corticosteroid use (59%) was for severe IIH not improving after discontinuation of ICIs. Additionally, 60% of the experts agreed on performing a biopsy for stage 2/3 acute kidney injury (AKI), and 70% recommended imaging for any stage of AKI. Thirty-five percent favored corticosteroids in AKI patients with creatinine levels 2-3-fold above baseline. For myositis, 58% would recommend a muscle biopsy in a patient with weakness and creatine kinase levels of 5000 U/L; 47% would also opt for an endomyocardial biopsy when the troponin levels are increased. Fifty-eight percent recommended oral corticosteroids for myositis, and 37% recommended additional therapy, mainly immunoglobulins. These results show substantial differences in expert practice patterns for the management of severe liver, kidney, and muscular irAEs.
对于免疫检查点抑制剂（ICI）相关的免疫相关不良事件（irAE）的管理，存在不同的建议。为了评估irAE在现实世界中的管理情况，针对ICI诱导的肝炎（IIH）、肾脏irAE和肌炎开展了三项调查，并发送给各领域的专家。共完成了56份调查问卷（17份关于IIH，20份关于肾脏irAE，19份关于肌炎）。所有专家都同意，对于每一例疑似严重IIH的病例都应进行影像学检查。65%的专家同意对未对皮质类固醇产生反应的患者进行肝活检。使用皮质类固醇最常见的指征（59%）是ICI停药后严重IIH仍未改善时。此外，60%的专家同意对2/3期急性肾损伤（AKI）进行活检，70%的专家建议对任何阶段的AKI进行影像学检查。35%的专家倾向于对肌酐水平高于基线2至3倍的AKI患者使用皮质类固醇。对于肌炎，58%的专家会建议对肌无力且肌酸激酶水平为5000 U/L的患者进行肌肉活检；当肌钙蛋白水平升高时，47%的专家还会选择进行心内膜心肌活检。58%的专家建议对肌炎使用口服皮质类固醇，37%的专家建议进行额外治疗，主要是免疫球蛋白。这些结果表明，在严重肝脏、肾脏和肌肉irAE的管理方面，专家的实践模式存在显著差异。
